Basic Fetal Monitoring Review. Ana H. Corona, FNP-C Nursing Instructor February 2009. Electronic Fetal Monitoring. Definition of fetal monitoring Method of assessing fetal status before and during labor Why is fetal monitoring important To provide insight that may affect fetal outcomes
Ana H. Corona, FNP-C
Definition of fetal monitoring
Method of assessing fetal status before and during labor
Why is fetal monitoring important
To provide insight that may affect fetal outcomes
Information is recorded on graph paper
Information is permanent part of the maternal medical record
Information is retrievable for litigation
FHR between 110-160 in gestations 32-40+ weeks
Rates slightly above 160 are normal in gestations less than 32 weeks.
Increases in the FHR associated with fetal movement that return to original rate range
Information for students is for educational purposes only
Students should not assume any responsibility for interpretation of fetal monitor tracings
It takes months to years of experience to be prepared to interpret fetal monitor tracings
Patient can move without much interference in data transmission
More accurate measurement of data
Data less likely to be affected by artifact
Membranes have to be ruptured and cervix dilated
Application requires more skill
Procedure is uncomfortable for the mother
Risk of trauma and infection for mother and fetus
Strip has two components
Upper graph - records FHR data
Small squares represent 10 bpm increases as well as 10 seconds duration
Lower graph records contraction data
Small squares represent 10 second duration or 10 mmHg intensity
Dark line to dark line represents one minute of time
Normal baseline FHR in a term fetus 37 completed weeks or more is 110-160 bpm.
Determination of the baseline FHR is done between contractions
Baseline is rounded in increments of 5 bpm example; if the FHR is running 125-135 then the baseline FHR should be documented as 130
Normal changes and fluctuations in the FHR over time.
Best assessed between contractions
Considered to be the best indicator of fetal well-being
Variability can be influenced by hypoxic events, maternal hemodynamic issues, drugs, etc.
Absent: Not detectable from baseline
Minimal: Less than 5 bpm from baseline
May occur with:
normal fetal sleep patterns
mother has received analgesia for pain
Moderate : 6-25 bpm from baseline (optimal pattern)
Marked: More than 25 bpm from baseline
Periodic: Refers to changes in the FHR that occur with or in relationship to contractions
Episodic: Refers to changes in the FHR that occur independent of contractions
Note the depth from the baseline
Deceleration of the FHR from the baseline lasting more than 2 minutes but less than 10 minutes.
No explanation for why these occur
Commonly associated with uterine hyperstimulation.
Can also occur without any uterine activity
Are the most common type of FHR changes
Are abrupt changes and will increase from the baseline 15 bpm lasting 15 seconds before return to the baseline in a healthy gestation more than 32 weeks.
Less than 32 weeks increases of 10 bpm lasting 10 seconds are indication of a well oxygenated fetus.
Periodic tightening and relaxing of the uterine muscle.
Pituitary gland is triggered to release a hormone called oxytocin that stimulates the uterine tightening.
Difference in Braxton Hicks contractions and true labor is the strength of the contractions and the changes in the cervix.
Frequency: How often they occur? They are timed from the beginning of a contraction to the beginning of the next contraction.
Regularity: Is the pattern rhythmic?
Duration: From beginning to end - How long does each contraction last?
Intensity: By palpation mild, moderate, or strong.
By IUPC intensity in mmHg
Subjectively: Patient description
Palpation: Use the fingertips to palpate the fundus of the uterus
Mild: Uterus can be indented with gentle pressure at peak of contraction
Moderate: Uterus can be indented with firm pressure at peak of contraction
Strong: Uterus feels firm and cannot be indented during peak of contraction
Variable decelerations in FHR during labor are severe dips occurring at the peak of contraction. This FHR problem is associated with which one of the following conditions?
A nurse is caring for a client in labor and is monitoring the FHR patterns. The nurse notes the presence of episodic accelerations on the electronic fetal monitor tracing. Which of the following actions is most appropriate?
A nurse is admitting a pregnant client to the labor room and attaches an external electronic fetal monitor to the client’s abdomen. After attachment of the monitor, the initial nursing assessment is which of the following?
A nurse is monitoring a client in labor. The nurse suspects umbilical cord compression if which of the following is noted on the external monitor tracing during a contraction?
The physician asks the nurse the frequency of a laboring client’s contractions. The nurse assesses the client’s contractions by timing from the beginning of one contraction:
When monitoring the FHR of a client in labor, the nurse identifies an elevation of 15 beats above the baseline rate of 135 beats per minute lasting for 15 seconds. This should be documented as: